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Building Permit #399 - 10 HEATH CIRCLE 12/17/2008
BUILDING PERMIT of NORTH TOWN OF NORTH ANDOVER t p APPLICATION FOR PLAN EXAMINATION zap w / t� Permit NO: . Date Received 9SSACHUs�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION" 'QS AA 0 0\k' , ^gy� pp. PROPERTY OWNER C t ,t Print MAP NO: 4 f PARCEU.� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Additi-Qn Two or more family Industrial Iteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer l DE � RIPT ON OF�wNORK TO BE PREF MED: ��5fi�ll� re.S, �ih) Identificationle se ype or Print Clearly) OWNER: Name: Phone: 9-?3- V1 '4393 Address: O �(C-A A CONTRACTOR Name: l� �M C Phone: QT? -A3" Address: Z � ' ,T J' 2 ' " 2 Z Supervisor's Construction License: 9�`'3' Exp. Date: 3 L07 Home improvement License: 1'5 220' 1 Exp. 'Date: 11/3 ARCH ITECT/ENG IN EER_N 1A Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ _7Q� FEE: $ �a " Check No.: ` Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access o the aranty fund ignature of Agent/Owner Signature of contras i — Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Swimming Pools Tanning/MassageBody Art Well Tobacco Sales Food Packaging/Sales - Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature j r COMMEI !TS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature &Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124:Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Application Revised 2.2008 Location /d 174 ,41 ex No. Date 0.1 N0RTh TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ ��sJwcHust`� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r uilding Inspector xAORTH '9 ® o Andover ; .W No. ? 9 ;== o dover, Mass., COCMICHEWICK 7�A0RATEO PPYL,��S `s BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR lAd THIS CERTIFIES THAT....... P/1 .. ......�G1/1'/ .................................................................................. Foundation has permission to erect........................................ buildings on .... .......A.4r4. .....1 ... .................................. Rough . T'1� to be occupied as.......S z .......A-re Chimney .... .................. ............................................................................................................. provided that the person accepting this permit sha in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes'and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS C®NSTRUC TARTS ELECTRICAL INSPECTOR Rough f ti.. ...........................................................:.. ..:............. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises -- Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Vin"' h d nRIA F _ \ e a P,VI 'S�q""'p'W ^moi^ r � S a breakthrough in price and qua lity �^ �., w A 3/ Y�,..:• 3 dw "_-"�' +�" -„� Sys '. 3S yam, AV z JIM OR k f � l, � � ? r / s q �/ r ;f OW OW E S fr g r � Solectria introduces the PVI 1800/PVI 2500 inverters: g a new standard of exceptional quality at an extraordinary price. Pill 18001PV12500 TECHNICAL SPECIFICATIONS Pil118001PVI20: "I ;1 d'.''§ +'ms`s '` ✓ p` f Ccnli.uous ver ':9SC VV 275,W Recommended Max.PV array power,STC rating 2200 Wp 3100 Wp _ MPPI"voltage range 125V DC-350V DC 125V DC-350V CC RELIABILITY M19axi:num voltage(ocv-cold) 40UV DC 400V DC The PVk1800/PVI 2400 protides Indgstry leading reliability.One look at automated produ�lgo and PCA assembly vnslydp the Maximum DC current 11 AUC 15 ADC inverter she;w3 its it dustrial quality,R;piously desigped dna tested f,-,r the harshest conditions,CYie PVI 1500/Put 2500 prove,to - n _6e rnnsfstegttp reliable, :. `�., - r i%` e _ Continuous power 1800 W 2500 W - - = Non mal voltage 240/208V AC 2401208V AC Voltage range 240208V AC-12%/,10% 240/208V AC-12%410% Nominal current 7.5A/8,7A 10.4A/12A E Frequcnty 60 Hz;+/ 1% 60 Hz,i/-1'6 � EASY TO INSTALL SAFETY Power factor Unity unity The PVI 1800/PVI 2500 can be'nstalled easily and quickly, The PVI 1800/P4 2500 has been tested to the I.A.1741 Diste Yon fsctor(THD) <4% 1 93% 93/overall efficiency : > hath indoors and outdoors.With a weight of 35't; (16 kq) standard and ince s all the requi ements.An'r-�portant operational �& (compared to a,average 70 Ib 132 kg)for a typical inverter; lolling point of this inverter is the galvanic isolation,which r: the PVI 1800/PVI 7500 1,very easy to handle The inverters increases both reliability and safety. • ' also include'pre-wired'AC and DC cables for quick wiring at DC and AC connections pre-wired pre-wired the jobsite without opening the inverter! HIGH THERMAL PERFORMANCE H-sing material Aluminium Aluminium Convection cooling Yes Yes/Fan All aluminlum construction and high efficiency design provl Weight 34.2 Lbs/15.5 kg 36,4 Lbs/16.5 kg EASY TO OPERATE:PLUG AND PLAY des full rated power In ambient temperatures up to 130`F Ambient temperature -13'F to+140"F -13°F to+140'F With,the PVI 1800/12500,Solectria once again confirms (54°C.No derating will occur: Relative hurn,dity 95% 95 Its innovative reputation.With:LCD display and auto detect Enclosure NEMA 4/IP 65 NEMA 4/IP 65 RS 232-485 as standard equipment,there is true'Plug and play'capability This gives the PVI 1800/PVI 2500 a PC interface with excellent monitorinq and data acquisition Length 18.5 inches(470 mm) 23.6 inches(600 mm) capability. A�u Width 13.1 inches(333 mm) 13.1 inches(333 mm) Height 5.63 inches(143 mm) 5.63 inches(143 mm) III Indicators LCD display&LEDs for status indication and error messages a External communication RS 232 or 485(standard equipment) "I (automatic recognition of RS 232 or 4851 e Data logger PVIDAQ :1'8 rrvl � :. u PC/Modem/Cell based logging Designed to meet UL listed to UL1741 UL Listed to UL1741 M r,,, ;;a 2 M IFF.E1547AF.EE929 IFEE1547AFF.E929 v, FCC part 15 A&8 FCC part 1 S A&8 a'. ANSI C62.41 C1&C3 ANSI 062.41 Ci&C3 a.1 Warranty Standard 5 years Standard 5 years s :re rr The Schuco Slim V high-performance solar - collector converts solar energy into heat and is excellent for providing domestic hot water as well as for heating swimming pools. The high quality "Sunselect" absorber coating and an optimized thermal insulation keep energy losses to a minimum. The absorbed solar heat is transported to a storage tank via a freeze-protected, non-toxic j, solar fluid by means of a serpentine copper V!yl pipe. IVIP!i� Besides optimized performance this aesthe- tically pleasing collector was developed with longevity and flush installation requirements in mind. HIGHLIGHTS • High efficiency due to"Sunselect"absorber coating. • Low energy loss due to ideal thermal insulation. • Robust aluminum frame for maximum durability. • High degree of reliability and long service life due to utilization of corrosion-resistant materials. • High transparency, low-iron glazing. • Suitable for sloped roof and flat roof installation. • Quick and simple installation with SolarEZTM mounting hardware,collector connectors, and installation accessories. • Serpentine piping,2 connections on long sides for portrait orientation of collector. • Certifications: SRCC OG-100,CE, DIN EN 12975-2, DIN CERTCO, EC guideline 97/23/EC, Blauer Engel(German ecolabel). Performance Characteristics Pressure Drop Characteristics ,� _ 1a E 0 r000 ...._. .. . ^:.. OA Boa —j — pp ....... ... W I ' 0,4 100 " y I H '00 -. 20 40 E0 BD EW 9?0 0 50 90@ U.j 2W 2W SG�3 AT/Eo[Km'.'Aj Mass Fl=[kg/hj Heat Transfer Medium Solar Fluid(20'C) TECHNICAL DATA Size 80.3 x 44.9 x 2.2 in. (2039 x 1140 x 56 mm) Collector Surface Area(Ag) 25 sqft. (2.32 m2) Weight(empty) 88 lbs. (40 kg) Efficiency >10=76.7% Heat Loss Coefficient k, =3.71 W/m2K;k2=0.016 W/m2K2 Incident Angle modifier k(50)=0.90 Thermal Output 1.64 kWth Absorber Long-Wave Emissivity is=5.0% Absorber Short-Wave Absorptivity a=95% Absorber Surface Area 23.1 sqft. (2.148 m2) Aperture Surface Area 23.0 sqft. (2.137 m2) Absorber Material Copper Absorber Coating Sunselect Heat Transfer Fluid Volume 0.42 gal.(1.6 Itr.) Minimum Volume Flow(up to max.4 collectors in series) 0.66 gal./min(2.5 Itr./min) Pressure Drop (0.66 gal./min solar fluid) 1.1 psi(78.0 mbar) Connection 12.0 mm Cu pipe,serpentine Type of Connector Compression fitting Operating Pressure 46.4 psi(3.2 bar) Permissible Operating Excess Pressure 145 psi(10 bar) Test Pressure 290 psi(20 bar) Stagnation Temperature 381 °F(194°C) Maximum Operating Temperature 248°F(120°C) Solar Glazing Low-iron, high transparency Transmittance >91.0% Thickness 0.16 in. (4 mm) Frame Material Aluminum Gaskets EPDM Thermal Insulation 0.79 in. (20 mm)mineral wool MISCELLANEOUS Sch0co article number Slimline V 222 908 Schuco installation system SolarEZTm Slim V Flyer 010506—All rights reserved.—Data given represent test results of an accredited German lab.-Specifications subject to change without prior notice. •t. • ' ! . i 0 J i • :s0 •o$ ! a V \f/ SCHUCO USA PRODUCT AND WORKMANSHIP LIMITED WARRANTY THIS WARRANTY IS PROVIDED BY SCHOCO USA,L.P.("SCHUCO")TO THE ORIGINAL CONSUMER PURCHASER("OWNER"). TWENTY-FIVE YEAR PRODUCT PERFORMANCE WARRANTY-PHOTOVOLTAIC MODULES Schuco warrants that all Schuco-manufactured photovoltaic ("PV") modules will be in keeping with Schuco's stated tolerances and standards for performance at time of sale to Owner.Schuco further warrants such PV modules will perform to a minimum of 80%of the specified rated output for a period of twenty-five(25)years from the date of purchase from a Schuco-authorized dealer.Schuco further warrants such PV modules will perform to a minimum of 90%of the specified rated power output for a period of twelve(12)years from the date of purchase from a Schuco-authorized dealer.Power output shall be measured under STC(Standard Test Conditions:Cell temperature of 25 degrees Celsius,radiation of 1000 W/m,spectrum AM 1.5)using a performance test accepted by Schuco.It is Owner's obligation to provide evidence that the PV module does not perform within said performance limits. TEN YEAR PRODUCT PERFORMANCE WARRANTY—SOLAR THERMAL COLLECTORS Schuco warrants that all Schuco-manufactured solar collectors(installed for use as heat collectors to provide energy for use in medium temperature range applications(110 to 210 degrees Fahrenheit))will be within Schuco's stated tolerances and standards for performance at time of sale to Owner. Schuco further warrants such solar collectors will perform and produce heat for a period of ten(10)years from the date of purchase from a Schuco-authorized dealer. FIVE YEAR PRODUCT INTEGRITY WARRANTY-NON-ELECTRIC COMPONENTS Schuco warrants that all non-electrical components(such as, for example, tanks, collectors, hydraulics, etc.)in Schuco's solar thermal and photovoltaic systems will be structurally sound and free of manufacturing, material or workmanship defects for five(5)years from the date of purchase from a Sch0co- authorized dealer. TWO YEAR PRODUCT INTEGRITY WARRANTY-ELECTRIC COMPONENTS Schuco warrants to the Owner that all electrical components(such as,for example, pumps,controllers, PV modules, etc.)in Schuco's solar thermal and photovoltaic systems will be structurally sound and free of manufacturing,material or workmanship defects for two(2)years from the date of purchase from a Schuco-authorized dealer. How To Obtain Warranty Service If a valid claim exists under one or more of the warranties, Schuco or its authorized representatives will repair, re-install, replace, or refund the purchase price of the failing Schuco product or part,at Schuco's option.In regard to valid claims of PV module or collector performance,Schuco may choose to fix the output performance to reach said limits, or replace the PV modules or remedy the situation in another commercially reasonable manner. If Schuco determines to replace any or all part or product, and if such part or product as originally installed is no longer available, Schuco shall substitute parts or products designated by Schuco to be of equal quality. Replacement of a part or product does not renew the warranty period. Minor color variations may exist between replacement product and the originally installed product and are not indicative of a defective product. This warranty includes labor expenses for removal and reinstallation up to a total of one hundred and fifty dollars($150.00) per system. To submit a claim, contact the Schuco-authorized dealer from whom the Owner purchased the product in question. A copy of this warranty and a copy of the original invoice may be required. Claims must be submitted promptly after discovery of the claimed defect and within the applicable warranty period. What Voids These Warranties Installation, removal, painting, repair, adjustment, tampering or re-installation of any Schuco products or components by other than a Schuco-authorized dealer voids any and all warranties,and Schuco expressly disclaims any liability for any costs,defects,or damages with respect to such actions. What Is Not Covered These warranties are granted by Schuco to the Owner only.The warranties only cover materials manufactured or assembled by Schuco and installed by a Schuco-authorized dealer. All warranties assume normal and reasonable use of Schuco products or components.These warranties do not cover damage caused by occurrences beyond the control of Schuco, such as defective, negligent or faulty installation, incorrect product configuration, building or zoning code violations,settlement of the building,failure of the structure(including foundations and walls),use of incompatible accessories, removal,repair,or re- installation of any Schuco products or components by other than a Schuco-authorized dealer, normal weathering and wear and tear, glass breakage, corrosive effects of salt air and chemical pollutants, normal fading, deterioration of non-Schuco approved caulking compounds,fire,flood, lightning, high winds,windblown objects,earthquake,hurricanes, ice dams,icicles and/or ice storms,atmospheric conditions or weather of catastrophic nature as defined by the US Weather Bureau,other acts of God, intentional acts,unreasonable use,vandalism or pollution. These warranties also will not apply to damages resulting from the failure to provide reasonable maintenance,including failure to clean the product,maintain sealing, painting and/or caulking as reasonably necessary,or clear off gutters or roofs as and when necessary. These warranties do not cover any damage or material failure or misalignment caused by objects dropped,thrown or placed against the products or due to combining any Schuco products with materials, components, gaskets,seals or operating hardware not approved for such use by Schuco. No warranties are valid unless and until the Owner has made full payment under the original sales agreement and all addenda thereto. Remedies and Rights These warranties of Schuco products and services are the only expressed warranties provided by Schuco. No employee, representative, agent, nor any other person,has authority to assume or incur on behalf of Schuco any obligation,liability,or responsibility in place of or in addition to these warranties. IN NO EVENT SHALL THE DURATION OF ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE BE LONGER THAN THE DURATION OF OWNERSHIP AND OCCUPATION,BY THE ORIGINAL OWNER OF THE HOME ON WHICH Schuco PRODUCT IS INSTALLED.EXCEPT FOR THE WARRANTY PROVIDED herein Schuco MAKES NO WARRANTY OF ANY KIND,EXPRESS,IMPLIED OR STATUTORY, INCLUDING,WITHOUT LIMITATION,ANY WARRANTY OF NONINFRINGEMENT,MERCHANTABILITY,OR FITNESS FOR A PARTICULAR PURPOSE. Sch0co'S LIABILITY TO OWNER (OR ANY SECONDARY HOMEOWNER)UNDER THIS DOCUMENT IS LIMITED TO THE AMOUNTS RECEIVED BY Schuco FOR SERVICES RENDERED UNDER THE SALES AGREEMENT OR PURCHASE ORDER WITH THE OWNER. SOME STATES DO NOT PERMITANY LIMITATION ON THE LENGTH OF AN IMPLIED WARRANTY,AND THEREFORE THE IMMEDIATELY PRECEDING SENTENCE MAY NOT APPLY. IN NO EVENT SHALL Schuco BE OBLIGATED OR LIABLE FOR INCIDENTAL,SPECIAL INDIRECT OR CONSEQUENTIAL DAMAGES OF ANY KIND FOR THE BREACH OF ANY EXPRESS OR IMPLIED WARRANTY OF Schuco PRODUCT OR SERVICES. SOME STATES DO NOT ALLOW EXCLUSION OR LIMITATION OF INCIDENTAL OR CONSEQUENTIAL DAMAGES, AND THEREFORE SOME OR ALL OF THE IMMEDIATELY PRECEDING SENTENCE MAY NOT APPLY. THESE WARRANTIES PROVIDE SPECIFIC LEGAL RIGHTS, AND YOU MAY HAVE OTHER RIGHTS WHICH VARY FROM STATE TO STATE. Schuco International KG g V,LA SOLAR COLLECTOR CERTIFIED SOLAR COLLECTOR CERTIFICATION AND RATING scala SUPPLIF...R: Scizoco International G Karolinenstrase 1-15 NA Bielefeld, D-33609 ''1 MODEL: Slimline V, LA. SR.CC OG-100 COLLECTOR TYPE: Glazed Flat-Plate CERTIFICATION#: 100-2005-009A COLLECTOR THERMAL PERFORMANCE RATING Megajoulesper Panel Per Day Thousands of Btu Per Panel Per Dav CATEGORY CLEAR MILDLY CLOUDY CATEGORY CLEAR MILDLY CLOUDY (Ti Ta) DAY CLOUDY DAY (Ti-Ta) DAY CLOUDY :DAY 23 MJrm�,d 17 MNnm.d 1 I MJIm`•d 2000 1500 Btu%ft`•d 1000 Bttr18'-d Btatitt-'-d A (-5°C) 36 27 1.8 A (-9°F) 34 25 1.7 B (5°C) 33 24 15 B (9°F) 31 23 15 G (200C:) 28 20 1.1 C (36°F) 27 19 11 D (50°C) 19 I1. 3 D (90°F) 18 10 3 E (80°C 9 3 E (144-F) 9 3 A-fool Heating(Warm Climate) R-Pool Heating(Cool Climate) C:-Wafer Heating(Warm Climate) D-Wat r.fleating(Cool Climate) E-Air Conditioning Original Certification Bate: December 20,2005 COLLECTOR SPECIFICATIONS Gross area: 2.311. m2 24.88 ft' Net Aperture Area: 2.141 m' 23.05 ft' Dry Weight: 41 kg 90 lb Fluid Capacity: 1.5 1 0.4 gal Test Pressure: 1103 kPa 1.60 psig COLLECTOR MATERIALS PRESSURE DROP Frame: Aluminum Flow AP Cover(Gaiter): Low Iron Tempered Glass gpm Pa in H2O Cover(inner): None 20 0.32 1979 7.95 Absorber Material: Tube-Copper f Plate-Copper 50 0.79 8473 34.02 Absorber Coating: Spattered cermet 80 1.27 19198 77.07 Insolation(Side): None Insulation(Back); Mineral Wool I'ECFINICA.L INFORMATION Efficiency Equation IN01'F: Based on gross area and(P)-Ti-Tal Y Intercept Slope S I )nits: rl= 0.706 -2.9209 (P)!I -0.0179 (Pf/I €1.715 -3.994 W,lin=.-C I P Q)nits: -1= 0.706 -0.5147 (P)!1 -0.0018 (P)211 0.715 -0,704 Btulhr-W-OF Incident Angle Modifier I(S)=Ilcos 0-1,0°S 0 560°1 Model'Tested: Slimline V k4z = 1.0 -0.0574 (S) -0.1117 (S)2 Test.Fluid: Water KAT = L0 -0.17 (S) (Linear Fit) Test Flow Rate: 43 mfr's 0.68 gpm REMARKS: November,2ttt3(i Certification must be renewed annually. For current status contact: SOLAR RATING&CERTIFICA17ION CORPORATION c%FSEC♦ 1679 Clearlake Road♦Cocoa,FL 32922♦ (321)638-1537+Fax(321)638-1010 tI A \ . z :, - W pa ay,L u I___..1 l} I z Hopedale AAA 01747 HEATING PRODUCTS Tel:508-422--9880 _ Fax:508-422-9881 y \ \ � a www.heat-flo.com Our dual-coil domestic hat water storage tanks are made in 60,SO and 7.15 gallon units.The lower heat exchanger coil can be connected to solar collectors,and the upper heat exchanger coil can he connected to ahot water boiler er for backup.The units are i provided with the two beating oils and tw y� \ prow o 3/8"ID theunnl wells to control each coil independently. Zh u) c \y � \ \ v; Wrap Cail' Bottom \::` ", a.•. . , ;. acting DAmemsrohs', '.r Dim®myons Pi e: :MoxWotktn ? Shi in a ••!' •'• '' Heat-Flo c..':• •,•.�� �`� " „-� :..,.Mode[ ..•Ca oc 'Su ac®,3 :..:Inches �::, Inches?' :` ,';Connections S:Pressure �- Wei ht• .:,. igu�l: �, �SgJI .(4.11a ncighl aiatY^tk}. �Z ��ips iso r � s tEsv.1:�Y t ki , x ��'• , \,_ F � 1 ��`•` a ;� HF715-D 115 7.4 87 72 26.5 . 1' 150 205 O 'zas:' ,1. 1� � 17s ��\ - •HF60-D 60 7.4 8.3 60 22.5 1" 150 165 ` a a ro Features and Benefits Include: �� 1oT�\ Quality Design and Construction ` o\ ■ Tanks and coils are all stainless steel for Ian9 life ■ Fast recovery.Large smooth coils deliver high output for years ' �• �„a„ �� ■ Low heat loss.Includes over 2”of urethane insulation,R-12. t l ■ Thermoplastic jacket will not rust or corrode. 2. Easy Installation 0 All connections are on top y ■ Brass drain and relief valves are factory installed a µ„ ■ Two thermostat wells to control each coil independently Models are available with 60,80 and 115 gallon tanks. a A1 Al ul� to - 4 -. �.. ;a :' r �_. ;^. � � ,,,<., ,• ;;. ,y`., ::;„; •l4lfirte�0� t115t�R�rx>� ��Water'Flavufe ; � Pressre OY R rye: ry� oP \ a _ ` `<t ;:,, `>Igaimavrl,�. �, (2altitaurl 7hka"ugii Cail � Through Catl, '': �3 , ' -: ...<: ��: '� '. .:• ` .�, ?": :,; �?•� Mdei..'.* T� Coil''• r :. Bortotn Coil r mt�io � •I8:bwmert 3�. . • �� a Ij HF115D X190 214 10 39 liamHF80-D 1811 211 alt?= ak 4 , HF60-D 185 214 10 3.5 IWI Note:All Ratings are based on 180 degree F water supply and 50 degree F cold water inlet. In the interest of continuous improvement,specifications are subject to change without notice. Approved Plumbing Products Online System by Massachusetts Board of Registration of... Page 2 of 5 4 Horne>Division of Professional Licensure>Board of Registration of Plumbers and Gas Fitters> SEARCH ......... ......... ... ......... ............___.__.............._..............___....... Approved Plumbing Products Online SystemOffice of Consumer Affairs ly By the Division of Professional Licensure ONLINE SERVICES Table. ONLINE PLUMBING PRODUCTS SYSTEM: SEARCH RESULTS Check a License Search Criteria: There are 42 record(s)in our database fitting your search criteria. Please note that Locate a Licensed Type: Plumbing if your product is not displayed in the Professional Manufacturer: Heat Flo, Inc. search results you can refine our search Product: y y Online Address Change Model: criteria. Contact the Agency Description: Displaying page of search results New_Search pages More... Requested products per page: 50 . DESCRIPTION, _.�..�. MANUFACTURER MODEL APPROVED EXPIRES APPROVAL APPROVAL CONDITION CODE SHEAT-FLO 115 JSTAIN STEEL INDIRECT Trade Name:: WATER HEATER jHeat Fto, Inc. ,HEAT-FLO 8/6/2008 =8/6/2009 131-0808.21 1 Trade i ..__. Model: 115 E 115-BT HEAT-FLO Trade Name: STORAGE TANKjHeat-Flo, Inc. HEAT-FLO ;8/6/2008 8/6/2009 P1-0808-21 Trade ' Model: 115- E BT 115-1) IHEAT-FLO Trade Name: i 'DUAL COIL INDIRECT =Heat-Flo,Inc. HEAT-FLO 8/6/2008 '8/6/2009'P1.0808 21 I Trade Model: 115- I 115-ST MEAT-FLO !Trade Name: HEAT-FLO STORAGE TANK ;Heat-Flo,Inc. Trade 8/6/2008 18/6/2009 Pt-0808.21 ' Model: 115- Heat Flo ....... ST Indirect Water Heater Heat-Fto, Inc. 30 1/8/2003 2/7/2010'P3 0207-287 Heat-Flo Insulated Storage Tank Heat Fto Inc. �30-ST 1/8/2003 ;2/7/2010 P3 0207 287 1....... ..... ....... ....... ............ ......... Heat-Flo Indirect Water Heater Heat Flo, Inc. 40 11/8/2003 2/7/2010'P3-0207-287 .......... 40-BT HEAT-FLO Trade Name: 1STORAGE TANK Heat Flo,Inc. HEAT-FLO8/6/2008 =8/6/2009 1 P1-0808-21 Trade { Model 40- BT Heat-Flo _ Insulated Storage Tank ,Heat-Flo, Inc. 40-ST 11/8/2003 12/7/2010 P3-0207-287 ......... ........ ... ............ ........... .......... HEAT-FLO ! Trade Name: STAIN STEEL INDIRECT Heat Fto, Inc. HEAT-FLO 8/6/2008 8/6/2009 P1-0808-21 WATER HEATER Trade ... ......... ..... Model 40L 3 401_-ST `Heat-Fto, Inc. Trade Name:.8/6/2008 8/6/2009'P1-0808-21 HEAT-FLO I HEAT FLO 1 STORAGE TANK Trade Model:: http://license.reg.state.ma.us/pubLic/pl_products/pb_search.asp?type=P&manufacturer=... 12/17/2008 PM 2 y -•....�./ o- �e 6, 7 ? <"..m.,., u,4� a s e;,,i , , r � Ulk nS OLI, af � �d. Th;ijn, k Bond ' �' SPRUCE LI N ETM New 195W module photovoltaic modules • Highest power and efficiency yet • Best available tolerance -0 / +2.5% A range of high quality poly-crystalline solar panels for on-grid markets offering exceptional performance, extraordinary versatility and industry- leading environmental credentials based on our cutting-edge String Ribbon'"wafer technology. Best-in-class performance ratings proven by field installations • 98%of rated power guaranteed for 180, 190W product; 100%guaranteed for 195W product i ' • 5 year workmanship and 25 year power warranty for ultimate peace of mind* • More installation versatility with our extensive range of mounting options • Higher strength with wind and snow loads guaranteed up to 80 Ibs/ft2 • Qualified to all major industry certifications and regulatory standards y ' Smallest carbon foot-print leading the fight ` 6 against global warming "r�r • Quickest energy payback time for the maximum ,. ,.... I energy conservation 1 l Cardboard-free packaging for minimal on-site waste O C and disposal cost TUV =__— i t .-,-. ._,_ ..-. *For full details'see the Evergreen Solar Limited Warranty available on request or online. This product is qualified to UL 1703,{JL Fire Safety Class C,IEC 61215,Ed.2;TUV Safety Clas"s`2 and CE String Ribbon and Spruce Line are trademarks of.Evergreen Solar Inc.String Ribbon is elks a patented technology of Evergreen Solar Inc. �w. Electrical Characteristics Mechanical Specifications Standard Test Conditions(STC)' 37.5 ES-180 �:E5-190 �E5-195' ° ( 5.6 0.16 RL,SL,TL or VL" •,RG,SL,TLwV4*- RL SL,TL or W. GROUNDING HOLE _ 3.5 0 Pmp2 (W) 180 190 195 Ptoerance (%) -2% -2% -0% Pmp,max (W) 186.1 194.9 199.9 i i m Pmp,min (VV) 176.4 186.2 195.0 ° 10x 0.26 Pptc3 (W) 159.7 168.8 173.3 n FOR 1/4"BOLT Vmp M 25.9 26.7 27.1 JUNCTION BOX (IP54) Imp (A) 6.95 7.12 7.20 P CABLES(AWG72) Voc M 32.6 32.8 32.9 Isc (A) 7.78 8.05 8.15 CLEAR ANODIZED ALUMINUM FRAME Nominal Operating Cell Temperature Conditions(NOCT)4 Pmp (W) 129.0 136.7 140.1 Vmp (V) 23.3 23.8 23.9 ; Me CONNECTORS Imp (A) 5.53 5.75 5.86 (Type 3) Vnc (V) 29.8 30.3 30.5 r N Isc (A) 6.20 6.46 6.59 5.6� 4x 0.16 GROUNDING HOLE TNOCT (°C) 45.9 45.9 i 45.9 0.16 GROU P P NDING HOLE '1000 W/mz,25°C cell tem erature,AM 1.5 spectrum; 1.6 35.9 Maximum power point or rated power i 'At PV-USA Test Conditions:1000 W/mz,20°C ambient temperature,1 m/s wind speed ? All dimensions in inches;module weight 40.1 lbs 800 W/mz,20°C ambient temperature,1 m/s wind speed,AM 1.5 spectrum # *RL model made in Germany without cell texturing;SL model made in USA Product construded with 108p poly-crystalline stalline silicon solar cells, anti- reflective without cell texturing;TL model made in Germany with cell texturing;VL tempered solar glass, EVA encapsulant,Tedlar®back-skin and a double-walled model made in USA with cell texturing anodized aluminum frame.Product packaging tested to International Safe Transit Association(ISTA)Standard 2B.All specifications in this product information sheet conform to EN50380.See the Evergreen Solar Safety,Installation and Opera- Low Irradiance tion Manual and Mounting Design Guide for further information on approved The typical relative reduction of module efficiency at an installation and use of this product. irradiance of 200W/m2 in relation to 1000W/m2 both Due to continuous innovation,research and product improvement,the specifica- ° tions in this product information sheet are subject to change without notice.No at 25°C cell temperature and spectrum AM 1.5 is 0%. i P P rights can be derived from this product information sheet and Evergreen Solar assumes no liability whatsoever connected to or resulting from the use of any Temperature Coefficients information contained herein. a Pmp (%/°C) -0.49 i Partner: et Vmp (%/°C) -0.47 a Imp (%/°C) -0.02 a Voc (%/°C) -0.34 a Isc (%/°C) 0.06 System Design Y g Series Fuse Rating' 15A UL Rated System Voltage 600 V s Also known as Maximum Reverse Current QELECTRICAL EQUIPMENT CHECK WITH YOUR INSTALLER S195_US_010707;effective July 1 st 2007 ......... .............. ........ .......... _..........._ ................--- _.i Worldwide Headquarters Customer Service—Arnericas and Asia=;•,, 138 Bartlett Street,MarIb6ro;MA-101 752.,USA ' j38Bartlett Street,Marlboro,MA 01752 USA Evergreen Solar lnc.�• T-+1 508.357.2221 F+1 508,229.0747 T+1.,508.357.2221 'F.+1`508.229.0747_-' www.evergreensolar.com .... _info0evergreensolar.Com �sales@euei�greensolarcorn .. �,� ate + � . ever green lar 6 SPRUCE LINETM photovoltaic modules Limited Warranty __ ......... ........ ..... ...._..... ......... ........ . Limited Warranty:Materials or Workmanship the modules were first installed.The limited warranties set forth herein are Evergreen Solar warrants the modules to be free from defects in materials expressly in lieu of and exclude all other express or implied warranties, including but not limited to warranties of merchantability and of fitness for or workman-ship under normal application, installation,use,and service particular purpose,use,or application and all other obligations or liabilities conditions.Ifthe product fails to conform to this warranty,then,for a period on the part of Evergreen Solar,unless such other warranties,obligations, ending sixty(60)monthsfromdatee original consumer urchaser or liabilities are expressly agreed to in writing signed and approved by Evergreen Solar will,at its option,either repair or replace the product or Evergreen Solar. refund the purchase price.The repair,replacement,or refund remedy shall be the sole and exclusive remedy provided under this warranty. Evergreen Solarshall have no responsibility or liabilitywhatsoeverfor damage or injury to persons or property,or for other loss or injury resulting from any Limited Warranty:Power Output cause whatsoever arising out of or related to the product,including,without Evergreen Solar warrants for a period of ten(10)years from the date of sale limitation,any defects in the module,or from use or installation.Under no to the original consumer purchaser that the power rating at Standard Test circumstances shall Evergreen Solar be liable for incidental,consequential, Conditions will remain at 90%or greater of Evergreen Solar's Minimum or special damages,howsoever caused. Specified Power Rating. Evergreen Solar further warrants for a period Evergreen Solar's aggregate liability,if any,in damages or otherwise,shall of twenty-five 25 ears from the date of sale to the originalconsumer y ( )y 9not exceed the payment,if any, received by seller for the unit of product purchaser that the power rating at Standard Test Conditions will remain at or service furnished or to be furnished,as the case may be,which is the 80%or greater of Evergreen Solar's Minimum Specified Power Rating. subject of claim or dispute.Some jurisdictions do not allow limitations on Evergreen Solar will,at its option,repair or replace the product,refund the implied warranties or the exclusion or limitation of damages,so the above purchase price,or provide the purchaser with additional modules to make limitations or exclusions may not applyto you. up lost power,provided that such degradation is determined to be due to Ifa part,provision,or clause ofterms and conditions ofsale,orthe application defects in materials or workmanship under normal installation,application, thereofto any person orcircumstance is held invalid,void,or unenforceable, and use. The relevant Minimum Specified Power Rating is defined in such holding shall not affect and leave all otherP arts,provisions,clauses,or Evergreen Solar' s product data sheet at the time of shipment.Standard Test applications of terms and conditions remaining,and to this end the terms Conditions are irradiance of 1000 W/mz,25°C cell temperature,and AM 1.5 and conditions shall be treated as severable. light spectrum. This warrant gives you specific legal rights;and you may also have other Limitations and Conditions Y9 Y P 9 9 , Y Y os rights that vary from state to state and country to country.Neither party The remedy set forth in these limited warranties shall be the sole and shall be in any way responsible or liable to the other party,or to any third party,arising out of nonperformance or delay in performance of the terms exclusive remedy provided under the extended term warranty, unless and conditions of sale due to acts of God,war,riot,strikes,unavailability of otherwise agreed by Evergreen Solar in writing.In Germany,these limited suitable and sufficient labor,and any uof reseen event beyondand its control,warranties are neither a"guarantee ofthequality" ofthemodule pursuantto including, without limitations, any technological or physical event or §443 BGB(German Civil Code)nor are they an"acceptance of a guarantee" pursuant to§276 BGB. condition which is not reasonably known or understood at the time of sale. The limited warranties set forth herein do not apply to any module which Any claim or dispute regarding these warranties shall be governed by and in Evergreen Solar's sole judgment has been subjected to misuse,neglect, construed in accordance with the laws of the State of New York(US). or accident; has been damaged through abuse, alteration, improper Obtaining Warranty a t Performance installation or application,or negligence in use,storage,transportation,or Y handling;or has in any way been tampered with or repaired by anyone other If you feel you have a claim covered by warranty,you must promptly notify than Evergreen Solar or its agent. the dealer who sold you the module of the claim.The dealer will give advice handling the claim.If further assistance is required,write Evergreen Solar The limited warranties do not cover costs associated with module for instructions. installation,removal,testing,packaging,transportation,or reinstallation; other costs associated with obtaining warranty service; or costs, The customer must submit a written claim, including adequate lost revenues, or lost profits associated with the performance or documentation of module purchase,serial number, and product failure, nonperformance of defective modules. Evergreen Solar will determine in its sole judgment the adequacy of such claim. Evergreen Solar may require that product subject to a claim be An modules repaired p air ed o replaced by Evergreen Solar under a warranty returned to the factory, P at the customer's expense.If product is determined claimshall be covered by the same warranties and original term as the first to be defective and is replaced but is not returned to Evergreen Solar,then product purchased under said claim.The term shall not be prolonged or the customer must submit adequate evidence that such product has been reset from the date of sate to the original consumer purchaser.Any replaced destroyed or recycled. parts or products become the property of Evergreen Solar. Note:This document may be provided in multiple languages.If there is a These limited warranties apply only to the first end-user purchaser of the conflict among versions,the English language version dominates. modules or to any subsequent owners of the original building or site where everg„ Worldwide Headquarters Customer Service-Americas and Asia reen Evergreen Solar Inc. Evergreen Solar Inc. 138 Bartlett Street 138 Bartlett Street Think Beyond. Marlboro,MA 01752 USA Marlboro,MA 01752 USA T:+1 508.357.2221 1 F:+1 508.229.0747 T+1508.357.2221 1 F:+1 508.229.0747 www.evergreensolar.com info@evergreensolar.com sales@evergreensolar.com Valid from 1"April 2007/W_US_010407 02007 Evergreen Solar,Inc. 1 f NexGen Energy Solutions, LLC Installation Agreement for Solar Electric Systems Qualifying for Massachusetts Technology Collaborative Small Renewables Initiative Incentives Customer: Mark Bohrer 10 Heath Circle North Andover, MA 01845 (978)289-0393 Contractor: NexGen Energy Solutions, LLC Will Thompson 1600 Osgood Street North Andover,MA 01845 (978) 688-2700 Grantor: The Massachusetts Technology Collaborative(MTC) 75 North Drive Westborough, MA 01.581-3340 Contract Sum: NEXGEN will furnish materials and mounting labor necessary to install the solar electric system as detailed in SRI Application Part 4 on a Time and Materials basis. The anticipated sum of this project is $18,904.28. Project Requirements: The project will comply with all of MTC's Minimum Technical Requirements(Attachment A). Termination: This contract shall be null and void if the MTC does not grant the Customer a Small Renewables Initiative incentive after receiving an application. Terms of Payment: 50% of the contract price will be due upon approval of the MTC SRI Rebate application 25%when materials are delivered to construction site 25%following utility interconnection approval(post-construction and inspections) This contract sum does not include fees for permits and approvals as may be required, which shall be obtained by the Owner/Contractor. Net Cost and Incentive Disclosures: The full value of the incentives applied to the Customer after all MTC Incentive Payments (assuming full production) shall be $4,275.00. The customer will be paid the first milestone payment, consisting of 90%of the total incentive reservation, after the installation of the system is complete and the MTC Project Completion Form has been submitted. NEXGEN will file the MTC Project Completion Form of the Customer's behalf, and the payment will be sent directly to the customer from MTC according to MTC's timetable,usually 60 days after the receipt of the Project Completion Form. Page 11 of 15 Version 1.5 a The performance-based milestone payment, consisting of the remaining 10%of the total Incentive reservation,will be paid to the Customer after 12 months of production reporting to the MTC Production Tracking System and, if applicable, completion of the energy efficiency requirements within the 12-month period completed by the Customer. Failure to report for any of the 12 months and/or complete the energy efficiency requirements within the 12 month period will forfeit the performance-based payment. Certification of Insurance: Customer will provide to NEXGEN a certification of an insurance policy offered by a commercial insurance company covering damage to the property including the PV system before construction can begin. The initial certification can be via a copy of a current insurance policy or statement on insurance company letterhead. The Customer,by signing this agreement,also agrees that she will maintain a policy covering damage to the property, including the PV system, for at least one full year from the completion date. Contractor Responsibilities: The contractor shall supervise and direct the work using the Contractor's best skill and attention. The Contractor shall be solely responsible for and have control over the construction means, methods,techniques, sequences, and procedures. The Contractor hereby certifies that all work performed as part of this contract shall be under valid licenses required by the Commonwealth to perforin said work. The Contractor shall obtain a similar certification from any subcontractor employed to perform work on the project. Change Orders: Any proposed change orders from either party in system specification, component location, technical support delivery, installation schedules, or payment schedules as described in this contract must be approved by both parties and result in a Change Order to this contract signed by both parties prior to the change being enacted. Changes in the system specifications, components, or installation schedules may be necessary due to circumstances beyond the control of NEXGEN such as, but not limited to: availability of components from supplier, subcontractor availability,unforeseen barriers to component installation such as immovable rocks or roots, water tables, buried electrical or water lines, changes in building regulations, extreme weather, or illness, death or disablement of a staff member of NEXGEN or its subcontractors. Warranties: Contractor warrants the full system for a period of three(3)years from the date of the completion of the installation. This warranty covers the cost of all repair or replacement components and associated labor and travel time. Contractor warrants to Owner that the installed PV system shall be free of defects causing a breakdown or degradation of electrical output of more than ten percent from the originally-rated electrical output for five (5) years from the date of completion. This warranty covers the cost of any required replacement components and systems required to restore the system to the warranted level of operation during the warranty period. Contractor warrants to Owner that the installed PV system shall be free of defects causing a breakdown or degradation of electrical output of more than twenty percent from the originally- rated electrical output for twenty years (not less than twenty years)from the date of completion. This warranty covers the cost of any required replacement components and systems required to restore the system to the warranted level of operation during the warranty period. This warranty Page 12 of 15 Version 1.5 w may be compiled with by a separate warranty form the module manufacturer duly assigned to Owner. In the event of a warranty claim,NEXGEN shall conduct a site visit within three(3)business days of the receipt of the request of service. This request can be received by NEXGEN via phone call, fax, email, or letter. NEXGEN will repair or replace components such that the system is operational within one month of the original service request. In determining the one month period,NEXGEN is nor responsible for system down time due to snow, leaves, dust, or other blockages shading the PV array or down time due to intentional or accidental system switches or component settings by anyone else other than NEXGEN personnel. These warranties shall be the Owner's exclusive remedy and are in lieu of any other warranties, express or implied and is in addition to and not in limitation of any other remedy required by law. Renewable Energy Credits: The Owner shall have title to the PV system's RECs,which have cash values as the non-energy attributes of the PV system. Other Terms and Conditions: Indemnification: To the fullest extent permitted by law, the contractor shall indemnify and hold harmless the MTC, its agents, officers and employees,against any and all liability, loss, damages,penalties, costs or expenses for personal injury or damage to real or intangible personal property with the Grantor may sustain,incur or be required to pay, resulting from, arising out of, or in any connection with the services performed by or delivered under the Agreement by reason of acts, inactions, omissions, negligence,recklessness or intentional misconduct or the Contractor or its officers, employees, agents or subcontractor(s)on this Project. Mediation/Arbitration: In the event of any disputes under this Agreement,the parties hereby agree to submit such dispute to binding arbitration in accordance with the Construction industry arbitration Rules. If any parry requests Mediation prior to Arbitration,the parties will mediate their dispute in accordance with the Construction Industry Mediation Rules. The parties to any such disputes shall share the mediator/arbitrator fees equally. Force Majeure: Neither party shall be liable to the other,or be deemed to be in breach of this Agreement for any failure or delay in rendering performance arising out of the causes beyond its reasonable control and without its fault or negligence. Such causes may include, but are not limited to, acts of God or a public enemy, fires, floods, epidemics,quarantine restrictions, strikes, freight embargos, or unusually severe weather. Dates or times of performance including the Terms of this Agreement shall be extended to the extent of the delays excused by this section,provided that the party whose performance is affected notifies the other promptly of the existence and nature of such delay. Severability: In the event that any provision of this Agreement is determined to be unenforceable or invalid under any applicable law, or is held unenforceable or invalid by any applicable court decision, such enforceability or invalidity shall not render this Agreement unenforceable or invalid as a whole, and, in such event, such provision shall be changed and interpreted to as to best accomplish the objectives of such provision within the limits of any applicable court decisions. Page 13 of 15 Version 1.5 v ` Controlling Law: This Agreement shall be governed in all respects by the laws of the Commonwealth of Massachusetts. Each party hereby expressly waives any objection to the personal jurisdiction and venue of the state or federal courts located in the Commonwealth of Massachusetts. Simatures Customer Date: 11 -7J Signature Mark Bohrer Name Contractor: Date: Signature Will Thompson Name Page 14 of 15 Version 1.5 a RESIDENTIAL SOLAR INSTALLATION CONTRACT NEXAMP,INC. 21 High Street,Suite 209 North Andover,Massachusetts 01845 (978)688-2700 This AGREEMENT is made as of October 22,2008 The Parties to this agreement are the Contractor,Nexamp,Inc.,and the Owner: Client First and Last Name:Mark Bohrer Client Street Address: 10 Heath Circle Town:North Andover State:MA Zip Code:01845 For work performed at the following location(if different from above): Site Address: Site Town: State: Zip Code: Description of the Project The scope of work includes the turn-key installation of a SchUco USA solar domestic hot water pre-heat system. The system will consist of four(4)Slim-V solar thermal collectors,one(1) 115 gallon stainless steel,dual-coil Heat-flo solar storage tank,one(1)Flatplate plate heat exchanger,glycol solar loop,and all necessary pumps,valves and controls. Time for Completion The work to be performed by the Contractor pursuant to this Agreement shall be commenced within 30 days of the date of this signed agreement. The work shall be substantially completed within 10 days of the commencement of the project. Exclusions Licensed plumbing interconnect including labor and materials for the boiler loop backup and DHW interconnect to be completed by others. The valves,pump and controls for the plate heat exchanger boiler side to be completed by others. The total cash price listed below assumes that existing roof structure meets Massachusetts Building Code 780 CMR. If Owner's roof structure is found to be non-compliant with the State Building Code,Nexamp may provide structural upgrades necessary to support solar system at Owner's expense. Owner will be furnished with an additional price estimate for the completion of this work. Payment Owner agrees to pay contractor a total cash price of$12,800.00. The payment schedule shall be as follows: • 50%due upon acceptance of this contract:$6,400.00 • 50%due upon construction completion and plumbing permit sign-off:$6,400.00 Payments are due on receipt of electronic invoice.Overdue payments will bear interest at the rate of 1-1/2%per month. Upon satisfactory payment being made for any portion of the work performed,the Contractor shall,prior to any further payment being made furnish to the person contracting for this improvement,a full and conditional release from any claim or Mechanic's Lien,for that portion of the work for which payment has been made. Terms and Conditions The Terms and Conditions attached hereto are expressly incorporated into this agreement. This Agreement consists of 3 pages. Nexamp,I /Buye Si ) B A it r TERMS AND CONDITIONS 1. CHANGES IN THE WORK Should the Owner,construction lender,or any public body or inspector direct any modification or addition to the work covered by this contract,the contract price shall be adjusted accordingly. NOTE ABOUT EXTRA WORK AND CHANGE ORDERS. Extra Work and Change Orders become part of the contract once the order is prepared in writing and signed by the parties prior to the commencement of any work covered by the new change order.The order must describe the scope of the extra work or change,the cost to be added or subtracted from the contract,and the effect the order will have on the schedule of progress payments.Failure to have written authorization shall not be deemed fatal to the collection of the extra work. 2. RESPONSIBILITIES OF THE PARTIES. Contractor shall promptly notify the Owner of(a)subsurface or latent physical conditions at the site differing materiallyfrom those indicated in this contract orb unknown , physical conditions differing materially from those ordinarily encountered and generally recognized ized as inherent in work of the character provided for in this contract. Owner as added work shall pay for any expense incurred due to such conditions. 3. DELAYS. Contractor agrees to start and diligently pursue work through to completion,but shall not be responsible for delays for any of the following reasons: failure of the issuance of all necessary building permits within a reasonable length of time,funding of loans,disbursement of funds into funding control or escrow,acts of neglect or omission of Owner or Owner's employees or Owner's agent,acts of God,stormy or inclement weather,strikes,lockouts,boycotts,or other labor union activities,Extra Work ordered by Owner,acts of public enemy,riots or civil commotion,inability to secure material through regular recognized channels,imposition of government priority or allocation of materials,failure of Owner to make payments when due,or delays caused by inspection or changes ordered by the inspectors of authorized governmental bodies,or for acts of independent contractors,or holidays,or other causes beyond Contractor's reasonable control. 4. PLANS&SPECIFICATIONS. If plans and specifications are prepared for this job,they shall be attached to and become apart of the agreement. 5. SUBCONTRACTS. The Contractor may subcontract portions of this work to properly licensed and qualified subcontractors. 6. FEES,TAXES AND ASSESMENTS. Owner will pay for taxes and assessments of all descriptions. Contractor will obtain and pay for all required building permits,but Owner will pay assessments and charges required by public bodies and utilities for financing or repaying the cost of sewers,storm drains,water service, schools and school facilities,other utilities,hook-up charges and the like. 7. INSURANCE AND FORCE MAJEURE. Contractor shall c 'YWorker's Compensation Insurance for the protection of Contractor's employeesrin p during the progress of the work. Contractor shall carry liability insurance to cover any damages to Owner's property resulting out of the acts of Contractor. Owner shall obtain and pay for insurance against injury to his own employees and persons under persons on the job site at Owner's invitation. a. If the project is destroyed or damaged by accident,disaster,or calamity such as fire,storm,flood, landslide,subsidence or earthquake,owner as extra work shall pay for work done by Contractor in rebuilding or restoring the project. 8. RIGHT TO STOP WORK. Contractor shall have the right to stop work if any payment shall not be made, when due, to Contractor under this agreement. Contractor may keep the job idle until all payments due are received. This remedy is in addition to any other right or remedy that the Contractor may have. Such failure to make payment when due is a material breach of this agreement. Owner acknowledges that the additional costs rZDcu3q -A , _z/0$ 2 Nexamp Initials Date Customer Initials Date v �r for the delay in stopping and starting the project shall be treated as an extra and allow Contractor additional costs in accordance with paragraph one hereof. 9. CLEAN-UP. Contractor will remove from Owner's property debris and surplus material created by this operation and leave it in a neat and broom clean condition. 10. LIMITATIONS. No action of any character arising from or related to this contract,or the performance thereof shall be commenced by either party against the other more than two years after completion of the project or cessation of work under this contract. 11. ATTORNEY FEES. In the event there is any litigation or arbitration arising out of this agreement,the prevailing party shall be entitled to its reasonable attorney fees and costs. 12. PAYMENT. Upon satisfactory payment being made for any portion of the work performed,the Contractor shall,prior to any further payment being made,furnish to the persons contracting for the improvement,a full and unconditional release from any claim or Mechanic's Lien,for that portion of the work for which payment has been made. 13. LIABILITY. IN NO EVENT WILL CONTRACTOR BE LIABLE IN CONNECTION WITH THIS AGREEMENT,FOR ANY INDIRECT,INCIDENTAL,SPECIAL OR CONSEQUENTIAL DANAMGES BASED UPON PRINCIPLES OF CONTRACT,WARRANTY,NEGLIGENCE,STRICT LIABILITY OR OTHER TORT,BREACH OF ANY STATUTORY DUTY,PRINCIPLE OF INDEMNITY OR CONTRIBUTION. NOTWITHSTANDING THE FOREGOING,CONTRACTOR'S CUMULATIVE LIABILITY FOR ANY CLAIMS ARISING UNDER THIS AGREEMENT SHALL BE LIMITED TO THE AMOUNT THE CONTRACTOR HAS RECEIVED FROM OWNER IN CONNECTION WITH THIS AGREEMENT DURING THE SIX MONTH PERIOD IMMEDIATELY PRECEDING THE EVENT GIVING RISE TO SUCH DAMAGES. 14. ASBESTOS AND HAZARDOUS WASTE. Unless the contract specifically calls for the removal disturbance, or transportation of asbestos or other hazardous substances,the parties acknowledge that such work requires special procedures,precautions,and/or licenses. Therefore,unless the contract specifically calls for same,if Contractor encounters such substances,Contractor shall immediately stop work and allow the Owner to obtain duly qualified asbestos and/or hazardous material contractor to perform the work or the Contractor may perform the work at contractor's option. Said work will be treated as an extra under the contract. i Nexamp Initials Date Customer Initials Date 1 2 , O D Solar Thermal System New i Existing Schuco USA 1 .5 kW Collectors Total Size: 6 kW D \� Photovoltaic Array Evergreen 195W Modules Total Size: 1950 Watts DC I-_ N w �'} Solar Electric and Hot Water System nexAmpBohrer Residence 10 Heath Circle " North Andover,MA 01845 drawn By:W Thompson 6/18/08 Not to scale a J 2 1" EMT conduit with 2 #10 --- - ----- PV Array(10, 195 Watt ❑Mno -ma o as❑nfl ❑❑❑rm U"U"Lj AWG, THWN-2 conductors QQQQo ❑flfl❑n o❑❑❑fl n❑❑fl❑ QQQQ modules in 1 string of 10 o❑QOII CI 0. QQQo❑ ❑❑ QQo❑fl and a ##10 A�►1'C,THWN-2 0110 000❑ °101rn] 00 10000 modules, notes 18x2) � aQ❑n fl❑❑Q a❑nfln fl❑❑oo 13=1 equipment groun-di g rinnorrOMn❑ fl7030Q101 ❑❑❑a ❑nt�n n❑❑oo II❑❑a❑ nfl©t7fl QQQ flfl❑flfl conductor. 4"X6"X4" ❑❑n❑❑ DOOM] a❑oan flC7flQ❑ aaa%]❑ LUJ NEW 4 Q❑"LKoa aflrrna l7fl❑i10 0❑aa flflflfl0 Approximate distance Junction QQQ❑Q n❑Mfl t�❑aa❑ nflo�o ❑❑❑❑❑ 11710101=3❑nnfl ❑QD❑❑ naQ❑❑ QQQ from way 'unction box to Bax ❑nnLM ana• n❑❑flQ Nate 3 DODaII ❑❑Q nnL9 >❑❑E7 ❑❑flQ switch is 30 feet ❑M[Y] na❑ ❑oQ❑a M010'M010' nava❑ ❑❑ 7 QQa❑- :1t❑n71 ODD❑ ❑fl❑nQ Q❑❑a❑ ❑QQQ- nn❑❑ ©naQ❑ nn❑flo ❑❑n❑ ❑❑❑❑ aQ0-❑fl❑n❑ ❑aIIa❑ AC power Source :• PV power...,., ai oonnec# : : Ma.im Servide source (200 Disconnect a IP :uv tFt 1 - Nate 4 arnp Two Po1 l:irC�Jlt-breaker for interactive Inverter is :point f adjacent toorinec#ioln pa nel . . . . . . . . . . RV Prod otlon Meter. Solectne Ren.ewa'bles, LLC. Grady evenue Integrated Inverter,:meter, and disconhects Panel F (notes 5, 6, 7, 6, 95 & 10) 1. PV Array contains I string of 10,195-watt modules in series(10 nodules total) 2. PV Array wiring to combiner is#10 AWG USE-2 with factory-instal led'MC€onnectors to modules, IklexCen Energy Solutions, LLC 3. PV Array Junction Box provides transition from array wiring to conduit%viring. 4. PV Power Source Disconnect(unfused)rated at 30 amps,6MVcic, NEMA 31x2 Rainproof. Title: Schematic PV 'System Drawing 5_ Ground Fault Protection provided in DC+AC lnterver. 6. DCIAC Inverter is PV1.1'SCO motel rated at 1.8 kW AC MAX output. Drawn by John IP Lagasse 7. Inverter is'listed to UL-1741"Utility Interaactive7 B. PV Output rneter is Form 2S kWh meter with ojdormeter register. December 07, 2007 9. 1riverter Output Disconnect rated at 3Qamps,240 Vac,NEMA 3R 10. 'Utility switch is visible open,lockable in open position-240-Vac,30-arnp switch. I JL. Equipment grounding conductors on AC-and DG-side sized according to NEC 254.122 12. Negative Pole of PV array referenced to ground at the inverter 13. All grounds connected to main service ground In Main Service panel. James A..Marx,Jr. 10 High Mountain Road Ringwood,NJ 07456 Tel.No. 973-557-6080 Fax No. 973-835-5924 E-mail:jamlight@bellatlantic.net August 1,2008 Unirac,Inc. 1411 Broadway Blvd.NE Albuquerque,NM 87102 To: Building Department or Others: RE: Engineer's Notice of Evaluation for UniRac SolarMountTM Universal PV Module Mounting;System for application to One and Two Family Dwellings in Massachusetts Dear Sir: I have evaluated the Unirac SolarMountTM"Code-Compliant Installation Manual 227", copyright February 2008.and certify that the information and results are accurate. To determine the design level forces,the.appropriate wind speed.and ground snow conditions must be determined as prescribed.by local jurisdiction requirements for Massachusetts and applied in accordance to the Seventh Ed.of the 780 CMR Massachusetts State Building Code(One and Two Family Dwelling)requirements. The Massachusetts State Building Code(One and Two Family Dwelling)requires that wind loading be determined based upon Table 5301.2(4)Basic Wind Speeds and Table 5301.2(2)Component and Cladding Loads for a Building with a Mean Roof Height of 30 feet in Exposure B and Table 5301.2(3)Height and Exposure Adjustment Coefficients for Table 5301.2(2)of which replaces Unirac's Manual 227 Table 2 and Table 3 that follows ASCE 7-02/05 requirements. The Massachusetts State Building Code is dependent upon conditions of spatial form,height,exposure category and other structure parameters that are specified in the,code provisions and illustrated in Figure 5301.2($). The Sixth Ed.of the 780 CMR Massachusetts State Building Code should be used to determine the snow loading on the solar panels that is imposed on railing and roof .mounting supports and.conditions of balanced snow,unbalanced snow and drift loads that will Heed to be determined. ' 4 James A. Mark;Jr. Page 2 of 3 For other building conditions not included by the Massachusetts,State Building Code (One and Two Family Dwelling), the determination of wind pressures(wind speeds must be converted to fastest mile wind velocities)and snow loads should be determined by the Sixth Ed. of the 780 CMR Massachusetts State Building Code that is referenced in Section 1610.0 and 1611.0. For determining the Total Design Load,the Unirac Part II procedure shall be replaced with Sixth Ed.of the 780 CMF,Massachusetts State Building Code, Section.1.616.2 that has Load Combinations Using.the Allowable Stress Design(ASD).for which the determination of distributed load on the railing,w(plf)and the uplift point load shall be obtained. The SolarMountTM railing distributed loading capacity,and anchorage requirements for the installation.are properly represented in the Installation Manual.227 for which Table 8 burnishes L-Foot SolarMount Series Rail Span and Table 12 furnishes.Lag pull-out (withdrawal capacities in typical roof lumber(ASD). The Unirac design verification is based on:. I. ASCE7-05—ASCE Standard Il. "Steel Construction Manual," 13th Ed.,American Institute of Steel Construction, Chicago,IL,2005. III. `°Aluminum Design Manual",The Aluminum Association,Washington D.C., 2005: IV. Mechanical Properties and Static Load Testing of Unirac extruded rails and related components obtained from Dr.Walter Gerstle,PE,Department of Civil Engineering,University of New Mexico;Albuquerque,NM Use: Unirac SolarMountTM is evaluated for use in locations where wind pressure requirements do not exceed 50 nsf or snow load conditions do not exceed 45 psf ground snow loads. For loading in excess of either of the above stated conditions,Unirac,Inc. should be contacted for suitability of installation. f James A.Marx,Jr. Page 3 of 3 By this letter,I certify that the Univac SolarMount"M assembly,when installed in accordance with the Installation Manual 227 and with the aforementioned application of bui the loading determination that will meet therequirements of the Wing codes adopted by Massachusetts. Others should evaluate the structure to which the Unirac SolarMauntTM system is to be connected on a.case-lay-case basis,per Part I Installer's Responsibilities of the Installation Manual,to ensure its adequacy to accept attachments and to support all applied loadings per the building code.. Please call me if you have any questions or concerns. Sincerely, James,A. Marx,Jr. ,Professional Engineer: MA License plumber 36365 cc:,carnes Madrid,Unirac w 780 CMR; STATE BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHUSETTS STATE BUILDING CODE TABLE 5301.2 5 MASSACHUSETTS GROUND SNOW LOADS 25 PSF 35 PSF 40 PSF 40 PSF 50 PSF / rewster Abington Alford Naliant - Acton Goshen Paxton cruor Agawam Arlington Natick dams Greenfield Pepperell hathamAmherst. Ashland eadham Amesbury Groton Peru estham Avon' Belmont New Braintree Andover Groveland Petersham arwich Belchertown. Bellingham New Marlborough Ashburnham Hamilton Phillipston artha's Vineyard Braintree Beverly New Salem Ashby Hancock Pittsfield antucket Brockton Blackstone Newton Ashfield Harvard Plainfield rleans Chicopee Blandford Norfolk Athol Haverhill Princeton lymouth Cohasset Boston North Brookfield Auburn Hawley Reading rovincetown East Longmeadow Brimfield Northampton Ayer Heath Richmond ruro Easton Brookfield Northbridge Barre. Hinsdale Rockport Wareham goxborough Brookline Norwood Becket Holden Rolyaiston ellfleet Granby Cambridge Peabodq Bedford Hubbardston Rowe Hadley Canton Pelham Berlin Hudson Rowley Hampden Charlton Quincy Bernardston Huntington Rutland Hingham Chelsea Revere Billerica Ipswich Salisbury Holbrook edham'. Russell Bolton Lancaster Sandisfield 30 PSF Holyoke ouglas Salem Boxhorough Lanesborough Savoy cushnet Hull Dover Saugus Boxford Lawrence Shelburne ttleboro Longmeadow Dudley Sheffield Boylston Lee Shirley arnstable Ludlow EastBrookfield Sherborn Buckland Leicester Shrewsbury erkley Mansfield Easthampton Shutesbury Burlington Lenox Spencer ourne Monson Egremont Somerville Carlisle Leominster Sterling ridgewater North Attleborough Everett Southampton Charlemont Leyden Stockbridgc artmouth Norwell Framingham Southborough Chelmsford Littleton Stow ennis Palmer Franklin Southbridge Cheshire Lowell Templeton ighton Plainville Grafton Stoneham Chester Lunenburg Tewksbury uxbury Randolph Granville Sturbridge. Chesterfield Maynard Topsfield stBridgewater Rockland GreatBarrington Sudbury Clarksburg Merrimac Townsend airhaven Scituate Hardwick Sunderland Clinton Methuen Tyngsborough all River Sharon Hatfield Sutton Colrain Middlefield Tyringham almouth South Hadley Holland Swampscott Concord Millbury Warwick" reetown Southwick Holliston Tolland Conway - Monroe Washington osnold Springfield Hopedale Upton Cununington Montague Wendell �..... alifax Stoughton Hopkington Uxbridge Dalton Monterey Wonham anover West Springfield Le'verott Wakefield. Danvers Now Ashford West Boylston anon Westfield Lexington Wales ` Deerfield Newbury West Newbury ngston Weymouth Lincoln Walpole Dracut Newburyport WestStockbridg akevilleWilbraham! Lynn Waltham Dunstable North Adams Westford anion Lynnfield Ware Erving North Andover Westminster arshfield Malden Warren Essex North Reading Williamsburg shpoe Manchester Washington Fitchburg Northborough Williamstown attapoisett Marblehead Watertown Florida Northfield Willmington iddleborough Marlborough Wayland Gardner Oakham Winchendon ow Bedford Medfield Webster Georgetown Orange, Windsor orlon Medford Wellesley. Gill Otis. Worcester embroke Medway West Brookfield Gloucester Oxford Worthington lymptonMelrose Westborough aynham Mention Westhampton ehoboth Middleton Weston ochester Milford Westwood - andwich Millis hatoly eekonk illville Winchester . omerset. Milton Winthrop wansea Montgomery Woburn aunton Mount Washington Worcester West Bridgewater Wrentham Westport Whitman 544 780 CMR-Seventh Edition 9/5/08 (Effective 8/8/08)-corrected •Maximum Span Calculator for Joists& Rafters Page I of I AC&01 A A Ameflcan Fofest&PaW. Association Maximum Sw%an Calculator Arnerican Wood Council for Joists & Rafters 0 Netscape D 4.XX Users-click here Species Spruce fi�ne-,Fir,,, Size ZX8,,; Gradel FF_T . .. ...................... --- --- Member Type jjRafters(Snow toad 7 F--Deflection Limit Fr' 7 Spacing Wet service conditions? Yes Exterior Exposure Incised lumber? [ No 01- Y Snow Load (p 1150 ............ ............. - ................. ........... ...............................-.. ...........-................... MIII Dead Load (p�Sbli OL r i F, Calculate.ma)(I 6o-,—T,o SPAN OPTIONS—CALC-U"LAT- OR�Orlfolsts,&-Ra i— RESTART OF' CS.*T The Maximum Horizontal Span is: 12 ft. 4 in. with a minimum bearing length of 1.15 in.required at each end of the member. I Property j Value Ispecies 11Spruce-Pine-Fir Grade No. 2 ISize I IModulus of Elasticity (E) -]11260000 psi Bending Strength (Fb) 111388.62 psi Bearing Strength (Fcp) 11284.75 psi Shear Strength (Fv) 11150.59 psi While every effort has been made to insure the accuracy of the information presented,and special effort has been made to assure that the information reflects the state-of-the-art, neither the American Forest&Paper Association nor its members assume any responsibility for any particular design prepared from this on-line Span Calculator.Those using this on-line Span Calculator assume all liability from its use. http://www.awe.org/calculators/span/calc/timbercalcstyle.asp?species=Spruce-Pine-Fir&s... 12/17/2008 Evergreen ES 195 Loading Panel Weight: 40. 1 lbs per panel Panel Mounting Hardware: 0.5 PSF Panel Area (each): 16. 1 SF Area Loading (each): 40.6 lbs / 16. 1 SF = 2.5 PSF Mounting: Unirac Solarmount — spec attached Rafters: 2 x 8 on 16 Span: 8' Max Allowable Span: 12'4" 2 Schuco Slim V Collector Loading Weight (dry): 88 lbs per panel Weight (glycol): 8.78 lbs per gal x 0.4 gal = 3.5 lbs Weight (filled): 91 .5 lbs per panel Panel Area (each): 25 SF Area Loading (each): 91 .5 lbs / 25 SF = 3.7 PSF Mounting and Fasteners: 4" steel lag bolts driven into rafters, 2 bolts per base plate, with a total of 4 base plates per panel Rafters: 2 x 8 on 16 Span: 8' Max Allowable Span: 12'4" 1 03/20/2008 06:00 9786820.713 RC L_AFOND INSURANCE PACS 02/02 AC�;'?RD,� .CERTIFICATE QF LIABILITY INSURANCE W°1�I.L aAo�WWI PADGUCER THIS CERTIFICATE IS ISSUED AS;A MATTER OF INFORMATION ONLY AND CONFERS NO RtGKtS UPON THE CERTIFICATE R. C. I woad Inavrance Agent► HOLDER.THIS CERTIFICATE DoES',NoT AMEND,EXTEND OR 396 And Ovex . reair ALTER TFIE COVERAGE AFFORDED 8Y THE POLICIES North Andover NA 01845 Phones 978-686-3886 Pax:978.682-0713 INSURERS AFFQRaNGCOVERAGE . HA1C# INSURED IirsuRa aA CSM06' lueureaaa.Cb.. gaInd. �rlsuR=R& Safe: Iareace G an 39454 & l4b"hr'det o messy Solutiow INWRER0 Ther Hartford DanD gt. 09 mIUR.ERQ Andover A 019 5 v4URER E. COWRAGts THE POLICIES OF MU NCE LISTED WL6W HAVE eEEW issutt TO TIS iNSU IM NAM A13ME FOR T>a£P.OUCY PERIOD INDICATED.NOTwffK7ANWNG Ari'/REOUIRFNIENT, OR WNDITION OF ANY CONTRACT OR OTHER OMUMENT Vint::RESPECT TO T4W"THIS CERTIFICATE MAY BE MWED OR MAY PERTAIN ,THE IN NCE AFFORM 8Y TK POUC ES 0=- RWI7 KFIFIN IS EMELT T6 ALL THE TI,31 %EXCWS10W�"iUNa C=MONS'OF BUCtl P OLIBIE8i AGGRICARE IM U 010W.M MAY WAVE BEEN ftltbU D R1'PAID CLAIM$'. . 1. POLICY NUMBER DA a ONDATE N LAM HSR OFINSEIRANGE O f,EIIERALLIAlIIntiTY MR OCCURRENCE 1:1000000 A X cvOrIMERCrALGENmviLIAanm k'1v M001796 01/17/0.$ 01/17/09 pRFJ�sE8tIBm )_ _ $50000 c1;alhns MADE accuR MIDEXPLA one ) 's I PCRSOHAL A ACV IWUaY $1000000 -- 1-- -� r,RIPALAr,MATE 12000000 j PRODVOTS•ccwiO0A0G s2000000 CI£N'LAQtiRE TE LIMIT APPUESPER; R11Tb iLE IA��TO'+ coMaw-h61NOL£LIMIT 'B3,000000 iso�w� ANY AUT ALL 0 I AUTOS i BODLY INJURY 8 8 ' x kwnuIIEDAUTW 15054724 O.l/il9J08 01/39/09 'r1p�°") HIREDA*M9 BDA14Y>POrt1RY g (Per amdart) NON-OWHSD AUTOS PRDPMYY DAMAGE $ : IPM OatmnO QRRAGEU AUTO ONLY;-EAAU09CK $ A "THFR WNY A EA Add i AVTOONLY: AGO 6 eOaCEBBOUM ELLALuIINITrr @q#I OCCIIRRENM s4000000. . A x occula EICLANSWOE CI ICN 000.205 O7/i7/D8 I 01/1'7/09 AOGREOA'M $4000000. s oDEDU ISLE A RUM oN $10000 o wommm I.R COMPe6ATION AND 8 TORYi IhAfTB ER _ C EMPLOYEMM,LumLnv DBF�SCRS7835 ` 0x/31/p8 01/33./09 F-LEACHAWDLWT 1500000 ANY PROPRIETOR AMCLUbED9 VRWECUME oFFICSE.LDIS F�S£-EAEMPtO q s$00000 RA Ny�i,domba E.L.DISEASE•POLICY LIMIT s S01)000, B?ECTAL PRCVl910 bdmu. OTFIr'R MCRIMIOMOF BlLOCATIONSfVEW s1LwiuS10N9ADDED BYEN PMTf9? CL%XPRCMMS S II3QAL 'T0: pi CONSORT ANTAM .TggTALMM OF #�NINABL2 MMRGY NgOPI3l+AT1C I CERTIFICATE HOLDInR CA14 RO AVON sWOUW plvv OF TWA SOM r0LI*"BE CANCELLED DEPORE TWR ExPd1 WN OA IMTmuRBCIF,TN@f VMGMURMMLI,15WEAVMTDAMM *Av%dVR0M NpsemtiOEceRTfl!fCATLHDI.eFRN►►M T1iEL[fit,BVTF TOOOsosOvuL x mpOSE N4 OBIUMATION OR LIADILKi UPON TM iT9 A4EM OR A£pR6S9ffATW AUTHOF"D REPRE9ENTA 1+Iiebo47. S. tO �A)lb-V-1 AI;ORD 25(2001108y 0171CIftA M 1908 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep-ibly Name (Business/Organization/Individual): Address: )T City/State/Zip: �� Q1�1� Phone #: �"Y Ly� Ayrou an employer? Check the appropriate box: Type of project(required): l. am a employer with G� 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. F1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.# 9. ❑ uilding addition required.] 5. ❑ We are a corporation and its 10.[g Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their l 1.[(Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.FOther comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 51ftil C�W5J AG::N kt-/ —ME MUM:��-/ � Policy# or Self-ins. Lie. f-_rk -H 3Y31 Expiration Date: 01 h(b Job Site Address: 1� c -CL City/State/Zip:)V- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify t e pain and penalties of perjury that the information provided above is true and correct. Si nature: — Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Board of ui Mations One Ashburton P ace, m 1301 Boston, llat:02108-161 License: CONSTRUCTION SUPERVISOR LICENSE _ Birthdate: 02/2311977 Number: CS 093023 Expires:02123/209,?.",-, Restricted To: 00 DWIGHT W THOMPSON 14—PATS"IREE"T IFSW;ICJ-1, MA 011938 Tr.no: 93023 . ..�. Keep top for receipt and change of aid,Q„s r:o.ifi .,�c.ar.6nn. DPS-CAI 0 50M-04/05-PC8698 Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement-Contractor Registration Registration: 153691 Type: Individual Expiration: 1/3/2009 Tr# 253746 DWIGHT W THOMPSON DWIGHT THOMPSON ---- - - ----- - 14 EAST ST _ -... IPSWICH, MA 01938 Update Address and return card.Mark reason for change. 5oM-Uc,`cs-F'C8698 i Address EI Renewal Employment -j Lost Card �......... ........ . .�,. "”" ��,� :1�ut�cinrru;�srtetr,�l�r-c�;.i�L+xz>�cr,✓ur�+�s. xieoxnian*r+na +a�izri ! 77, Board of Building Regulations and Standards [ i aGARD OF t3lLUiN£s Rt^G11L TlC NS r, HOME IMPROVEMENT CONTRACTOR ' Lic�^Fase COSTRCTi(YN S1}P.EItSOR 3 r iT Registration 153691 F Nat h CS 093023 Ezp�ration:. 1"13/2009 Tr# 253746 f r h a { f197? Type. Individual E�€prt i2/23/2IIf9'' Tr,ro 93025 DWIGHT W THOMP50N Re �cte�7� DWIGHT THOMPSON pvVtUl tT TH04 ;"rl 14 EAST ST 4 REIPSWICH,MA 01938 Administrator IPS17UICH, MA 0I938 Gorit5issianer